Lead Medical Claims Examiner

Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way. As Gravie looks to continue its Member-centric approach to healthcare, the Lead Medical Claims Examiner will support, review and adjudicate claims in our best in class claim system.  The Lead Examiner will be a subject matter expert, capable of thoroughly evaluating, researching and analyzing claim submission, with a solid knowledge of national claims guidelines. In addition to personally reviewing complex claims, the Lead Examiner will play a key role in elevating the performance of the team, assisting in training, serving as a resource to other Examiners and pitching in as needed with special projects. You will:·       Lead team discussions and aid in team issue resolution·       Lead team in testing claims and system configuration·       Aid in coaching team members, sharing expertise, best practices and offering constructive feedback·       Process claims within our claims queues, and adjudicate based on claims rules·       Review pended claims queues and provide expertise to address with appropriate parties·       Periodic claims and process auditing to improve department outcomes·       Continually meet department metrics and quality·       Communicate complex claims issues clearly through documentation and direct communications·       Ability to utilize multiple applications to fulfill all job functions You bring:·       4 + years of experience processing/adjusting and/or analyzing medical claims·       Strong knowledge of CPT/HCPC and ICD-10 code rules·       Ability to set priorities, manage time and work independently·       General knowledge of CMS claims submission regulations·       Demonstrated success getting results through collaboration Extra credit:·       Medical Coding experience/ Certification·       Medical Billing experience·       Understanding of provider data·       Previous start-up company experience·       Degree in Healthcare Administration or similar field. Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.